Emphysematous pyelonephritis in a non-diabetic patient associated with nephrolithiasis : a rare case report

Abstract

Introduction: Emphysematous pyelonephritis (EP) is an acute renal infection, potentially fatal, with high mortality, which is more frequent in women at fifth decade of life. Herein, we describe a case of EP successfully treated with surgery. case report: A 50-year-old female was admitted with complaints of lumbar pain, irradiating to ipsilateral lower limb, associated with nausea and fever (38.9ºc), with chills. Abdominal computed tomography (ct) scan showed amorphous echogenic image, with gaseous component, inside the right kidney, and pyelogram showing lithiasis in the right renal pelvis and filling defect. Urine culture was positive for Escherichia coli . Antibiotic therapy was initiated with piperacillin- tazobactam and opioids. On 15th day of hospital stay, she underwent a right nephrectomy. the histopathological analysis evidenced numerous sclerosed glomeruli, tubules with atrophy, inflammatory infiltrate in the interstitium. she was discharged with complete resolution of the infection, asymptomatic and with normal renal function. conclusion: Emphysematous pyelonephritis is a rare, atypical, and severe form of renal parenchyma infection. Early nephrectomy (<1 week) is associated with increased mortality in comparison to conservative treatment. In this case, the patient underwent an elective nephrectomy due to the chronicity of the disease, with successful recovery.